Ending Unequal Treatment Strategies to Achieve Equitable Health Care and Optimal Health for All (2024) / Chapter Skim
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8 Accountability
8 Accountability
Pages 281-306
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From page 281... ...
Amidst significant changes, inequities persist, and advancing toward an equitable health care system that contributes to achieving optimal health for all remains a desired goal and one of the drivers of this consensus study. But the findings presented in this study also underscore just how far the nation has to go where health care equity is concerned, by documenting the extent to which, 2 decades after Unequal Treatment, racial and ethnic inequities remain throughout the health care system.
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From page 282... ...
Chapter 7 discusses how research can further support progress toward eliminating health care inequities and advancing health equity. The committee recognizes that many initiatives to change how the health care system functions have not been successful despite multiple national reports with actionable and thoughtful recommendations for improvement, and efforts to advance racial and ethnic health care equity have not resulted in long-term gains.
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From page 283... ...
health care system as a whole and individual health care systems and "health" when discussing outcomes. ACCOUNTABILITY STRUCTURES AND PROCESSES Creating systems of accountability to ensure that laws and policies have their intended impact to achieve health care equity and optimal health for all without unintended consequences is a major challenge in the United States.
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HEALTH CARE LAWS AND PAYMENT POLICIES Legal and Policy The Agency for Healthcare Research and Quality has published the National Healthcare Quality and Disparities Report to highlight trends across health care settings over the past 2 decades. Federal, tribal, state, territorial, and local governments have made efforts to hold themselves and other actors accountable for reducing racial and ethnic health and health care inequities.
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See https://www.cdc.gov/nchs/hus/sources-definitions/msa.htm (accessed April 29, 2024)
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: To mechanisms including executive orders, congressional actions, and federal agency initiatives. Recent executive orders have aimed to strengthen equity throughout government, including areas in the health care sphere where the federal government has the greatest influence (e.g., access to health care, payment of services, and health care professional training)
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by making high-quality health care accessible and affordable for everyone in the United States. The order addresses health inequities by establishing a Special Enrollment Period for uninsured and under insured Americans to seek coverage through the Federally Facilitated Marketplace, as well as reviewing and potentially revising or rescinding agency actions that may undermine protections for people with pre existing conditions, reduce coverage under Medicaid or the ACA, or present barriers to accessing health care coverage.
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From page 288... ...
H.R.4585 - Advancing Maternal Health Equity Under Medicaid Act of 2023: This bill would amend title XIX of the Social Security Act to provide a higher federal matching rate for increased expenditures under Medic aid for maternal health care services. H.R.3305 - Black Maternal Health Momnibus Act of 2023: This bill would target ending preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the U.S., and invest in ad dressing adverse social determinants of health that influence maternal health outcomes.
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Brief Summary of Document Action Department HHS Equity This plan describes actions HHS can Plan of Health Action Plan take to advance health equity and and Human (2022) 2 institutionalize a focus on it, highlighting Services five key HHS activities as examples.
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(2022) 10 Continued 6 See https://www.cms.gov/newsroom/press-releases/cms-proposes-policies-advance-health equity-and-maternal-health-support-hospitals (accessed April 29, 2024)
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. 13 See https://www.nimhd.nih.gov/docs/nimhd-strategic-plan-2021-2025.pdf (accessed April 29, 2024)
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For example, OCR works toward accountability by providing guidance to states on their legal obligations to provide insurance coverage to children and families under the Children's Health Insurance Program. This guidance has been critical during Medicaid unwinding after the Families First Coronavirus Response Act continuous enrollment condition expired.17 At a minimum, governmental and institutional efforts to overcome past and ongoing racism need to be able to identify a compelling need for raceconscious policies and pursue them only if they are narrowly tailored as the least restrictive means for furthering a compelling interest.
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HEALTH CARE DELIVERY SYSTEM As discussed in Chapter 5, the health care workforce is not representative of the diverse U.S. population that is serves, and both federal and nonfederal partners can develop and support a diverse workforce essential for achieving equitable health care and optimal health for all.
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Nongovernmental organizations also can support health care workforce alignment with health equity priorities at the structural level. Opportunities for building accountability through health education accreditation standards, health professional licensing and certification, and accreditation of health care organizations are promising.
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. Tracking and documenting differences in health and health care–related outcomes between population groups is a common approach used by public health and health care delivery systems; however, measuring health equity is more complex and poses substantial challenges (Penman-Aguilar et al., 2016)
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From page 296... ...
In addition, different standards for acceptable performance measures to achieve optimal and equitable health for all have impeded efforts to hold health care systems, organizations, and providers accountable for their performance. Chief Diversity and Equity Officers The murders of George Floyd, Breonna Taylor, and Ahmaud Arbery in 2020 sparked public outrage on racism and once again forced many people to confront the role of structural racism in the nation's criminal justice system (Nguyen et al., 2021)
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Although internal-facing workforce diversity, equity, and inclusion efforts and external-facing health inequity reduction or elimination efforts may both require understanding structural and systemic racism, their goals and the training and skills necessary to successfully implement the respective programs are different. Health care organizations need to distinguish efforts aimed at workforce diversity from those targeting equity in patient care delivery and health in their catchment area (Crews et al., 2021)
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As for health professional schools, accreditation criteria that embrace and promote interventions, care delivery models, and organizational practices and policies that improve health equity are powerful for incentivizing positive changes. Examples exist of increasing consideration of health equity in accreditation.
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They are uniquely positioned to ensure that health equity-focused education and training is implemented across many sanctioned educational institutions. However, a review of accreditation criteria in the U.S and Canada found that essential competencies for equitable health care delivery were still omitted (Orban et al., 2022)
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In March 2024, OMB released revised race and ethnicity data standards that add Middle Eastern or North African as a new minimum category and require collecting more detailed race, ethnicity, and tribal affiliation beyond the minimum categories as the default. Federal agencies are expected to submit an Agency Action Plan for complete compliance with the updated standards within 18 months and to be fully compliant within 5 years.22 OMB plans to establish an Interagency Committee on Race and Ethnicity Statistical Standards that will "maintain and carry 22 See https://www.federalregister.gov/documents/2024/03/29/2024-06469/revisions-to-ombsstatistical-policy-directive-no-15-standards-for-maintaining-collecting-and (accessed April 1, 2024)
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A major barrier to greater accountability in health care equity is a system designed to rely on market forces, when equitable outcomes are often not based on capitalist structures (Frank and Shim, 2023)
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Most health care payment models do not explicitly tie payment to reducing racial and ethnic health care inequities advancing health equity. 24 See https://health.gov/healthypeople (accessed April 24, 2024)
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New England Journal of Medicine Catalyst Innovations in Care Delivery 1(4)
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2023. Distinguishing health equity and health care equity: A framework for measurement.
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NEJM Catalyst Innovations in Care Delivery 1(5)
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